Healthcare Provider Details
I. General information
NPI: 1841010709
Provider Name (Legal Business Name): OUT WATER MEDICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/15/2024
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
251 ROCHELLE AVE STE B
ROCHELLE PARK NJ
07662-3914
US
IV. Provider business mailing address
PO BOX 353
ROCHELLE PARK NJ
07662-0353
US
V. Phone/Fax
- Phone: 201-291-8800
- Fax: 201-291-0637
- Phone: 201-291-8800
- Fax: 201-291-0637
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085U0001X |
| Taxonomy | Diagnostic Ultrasound Physician |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2081P2900X |
| Taxonomy | Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
FRANCIS
W
MEO
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 201-291-8800